CMS Price Transparency Data

Group therapy session

Facility: Loma Linda University Medical Center

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $257
Cash Discount Price: $185
vs. Medicare Baseline: 2.48x Medicare

The contracted insurance negotiated median rate for a Group therapy session at Loma Linda University Medical Center is $257. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $185. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 2.48x the Medicare baseline. Located in 11234 Anderson St, Loma Linda, CA.

Cash / Self-Pay

$185

Average discount available for prompt cash payment at this facility.

Insurance Median

$257

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$103.79

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $103.79 (100%)

Cash / Self-Pay: $185 (178%)

Insurance Median: $257 (248%)

Cash: $185 (178% of Medicare)

Ins. Median: $257 (248% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $103.79 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 248% of the Medicare baseline (a markup of 148%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Inland Empire Health Plan (Iehp)	$41 - $118	40%
Kaiser Foundation Hospitals	$46 - $1,235	44%
Adventist Health	$48 - $370	46%
Lluh Dept Of Risk Management	$52 - $370	50%
Blue Shield Of California	$95 - $674	92%
Epic Health Plan	$96 - $741	92%
Blue Cross Blue Shield	$116 - $1,088	112%
Alpha Care Medical Group	$118 - $176	114%
Dignity Health	$118 - $176	114%
UnitedHealthcare	$118 - $926	114%
Upland Medical Group	$118	114%
Vantage Medical Group	$118 - $176	114%
Prime Health Services	$125 - $1,574	120%
Riverside University Health System	$129	124%
Global Benefits Group	$143 - $1,111	138%
Temecula Valley Physicians Medical Group	$143 - $1,111	138%
Trivalley Medical Group	$143 - $1,111	138%
Aetna	$145 - $1,125	140%
Cigna	$153 - $1,370	147%
Networks By Design	$155 - $1,204	149%
Molina Healthcare Of Ca	$157	151%
Multiplan	$179 - $1,389	172%
Central Health Plan	$191 - $1,482	184%
Heritage Provider Network	$193	186%
Galaxy Health	$203 - $1,574	196%
Health Management Network	$215 - $1,667	207%
Health Net	$610 - $800	588%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $185.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90853.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Loma Linda University Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90853.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.